Surgical Robots Operate With Precision

Dread going the doctor? It could be worse. Your next physician could have the bedside manner of a robot. In fact, your next physician could be a robot.

Scared yet?

Surgeons and medical engineers have been trying to create machines that can assist in surgery, increase a surgeon’s dexterity and support hospital staff. These aren’t humanoid robots but computer controlled systems that have been optimized for use in sensitive situations. An exhibition called Sci-fi Surgery: Medical Robots, opening this week at the Hunterian Museum of the Royal College of Surgeons of England, shows a range of robots used in medicine.

“Industrial robots appeared in factories in the early 1960s and robots have become an important part of space exploration,” says Sarah Pearson, curator of the exhibition. “But robots have been comparatively slow to be used in medicine because surgeons haven’t felt comfortable with them.”

Robots in medicine aren’t intended to replace surgeons, says Pearson, but act as companion devices. Most robots used in medicine aren’t autonomous because surgeons haven’t been comfortable giving up control, but with advances with technology, we can expect more autonomous machines.

The exhibition offers a peek into some of the most interesting surgical robots out there, from one of the earliest medical robots to a prototype camera pill.

Above: PROBOT

In 1988, Brian Davies, a medical robotics professor at the Imperial College in London, designed a robot (with help of colleagues) that could remove soft tissue from a person. It was one of the first robots to do so. What’s more, it could perform the task with a fair degree of autonomy.

Most industrial robots usually have an arm, complete with a shoulder, elbow and wrist mechanism, and a gripper tool for the hand. That’s overkill for surgical purposes, and because of the room needed to move a robot arm around, it might even be dangerous for use in very small spaces inside human bodies. That’s why Davies and his team designed a small robot that has three axes of movement, plus a fourth axis to move a cutter for prostate surgery. (See a simplified drawing of the robot’s structure.)

The geometry of this design allows the robot to hollow out a cavity from within the prostate gland. The robot is controlled by a pair of programmable embedded motor control systems. The system are directed using a i486DX2-based PC. The robot allows surgeons to specify the correct cutting sequence to remove tissue.

But the idea of having any degree of independent behavior in a robot didn’t catch on. Although its designers tested the PROBOT in the lab and in human subjects, it was never used widely in surgery.

“Doctors just didn’t feel comfortable with the idea,” says Justin Vale, a consultant neurological surgeon at Imperial College and a fellow at the Royal College of Surgeons. “The PROBOT project shut down when funding for it ran out.”

The da Vinci robot is no beauty but it serves the needs of surgeons very well. The robot is a surgical system that was first sold in 2000 by Intuitive Surgical for use in cardiac surgery and treatment of prostate cancer.

A “master-slave” system, the robot allows surgeons to sit at a console away from their patient while the robot mimics their movements. The system has three parts: a surgeon’s console, a cart that sits by the patient and has four arms that can be manipulated by the surgeon, and a high-definition 3-D vision system.

It’s an easy to use set-up that’s still used in surgical procedures, says Vale. The 3-D view gives surgeons an advantage over the two-dimensional screens found in traditional laparoscopic procedures. It also gives surgeons a high-resolution, highly magnified view of what they’re operating on.

“The instruments have seven degrees of freedom of movement, which means they are capable of the same movement as human wrist and they are intuitive for surgeons to use,” says Vale.

In the fact, the da Vinci robot has been so successful that the system is now in its third generation and even offers a high-definition view.

An active robot designed in 2001, the Bloodbot is tasked with taking blood samples from an area in the crease of the arm. Simple as that sounds, the Bloodbot’s biggest challenge is in finding a vein, since the pattern of veins varies across individuals.

To avoid a bloodbath in its quest for a vein, the Bloodbot presses a probe against the surface tissue and measures the force on the probe. The pressure difference across the area indicates the presence of a vein. Once the Bloodbot finds a vein it inserts a needle and draws the blood. The system is sophisticated and precise enough to ensure that it doesn’t insert the needle too far into the vein or overshoot the vein. Three powered axes and one powered rotational axis make up this robot — a relatively simple design compared to others in this gallery.

Just don’t ask it to be gentle because you are scared of needles. You know your pleas aren’t going to make any difference to a robot.

Caption: Bloodbot, a prototype robot for taking blood samples, developed by Dr Alex Zivanovic and professor Brian Davies at Imperial College London, 2001.

Imagine tiny individual components, no bigger than a pill, that when swallowed would reassemble themselves inside the human body and give surgeons access to your insides without the mess and gore of invasive surgery.

It’s not science fiction but an experimental project called ARES, for Assembling Reconfigurable Endoluminal Surgical System (Google Doc link). The ARES robot prototype requires patients to swallow up to 15 different modules, each between 0.1 and 0.5 cubic centimeters in volume. The modules would include elements such as a tiny power supply, a communications unit, a processing module, a camera and control chip.

Some of the modules will be biodegradable, while a few will have to be removed physically. The ARES idea is still under development but if successful, expect to see external smart machines working their way through the human body.

Laparoscopy, which allows surgeons to make very small cuts, is currently one of the most popular techniques in surgery. A robot only helps make the process easier.

The FreeHand camera is a 15-pound robotic device that gives surgeons direct control of the laparoscopic camera through a light-weight, hands-free controller. The controller is worn on the surgeon’s head so with gentle head movements doctors can position the camera where they want. It’s better than handheld devices because the system offers a steady image and eliminates the need for an assistant to hold a camera probe during the surgery.

As you recover from your robotic surgery, you might meet your night duty nurse, the RI-Man. One of the few humanoid robots designed for medical use, Japanese company Riken created a 5-foot tall robot that could act as a helper in hospitals. The robot weighed about 220 pounds and has arms that could lift up to 80 pounds.

The robot’s sensors allowed it to determine where sound is coming from, and can also detect faces. It had about 320 pressure points on its arms and chest so it could, in theory, lift a patient carefully (future versions were expected to be strong enough to do this).

The RI-Man was so impressive that it made Time magazine’s best inventions of 2006 list. Unfortunately, Riken shut down development of the RI-Man. The company is now reportedly working on developing a new version called RIBA.

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